A Clinical Safety Assessment of Hybrid Fractional Laser Use at Increased Depths for Facial Skin Rejuvenation

Background: Hybrid fractional lasers (HFL) have significantly improved treatment methods for laser resurfacing via dual wavelength technology. However, the safety of HFL at depths beyond 150μ is debated, particularly for its non-ablative wavelength, though some suggest that deeper HFL enhances skin remodeling and rejuvenation. We aimed to assess the safety of deep HFL therapy among patients concurrently undergoing rhytidectomy for facial rejuvenation. Methods: A single-site retrospective review from 2017 to 2022 included patients who underwent rhytidectomy with or without concurrent intraoperative HFL therapy. Data was collected on patients' demographics, details of HFL therapy, and postoperative complications to compare differences between groups. Results: A total of 169 patients were included, aged 63.3 ± 7.5 years with a Fitzpatrick score of 2.7 ± 0.7. Characteristics, comorbidities, and surgical history were similar between groups. The average non-ablative laser depth was 355μ ± 25μ for the face, with a maximum of 425μ. In the following 12 months, 7.6% of the HFL group and 3.0% of the control group experienced postoperative complications. This difference was not significant (p=0.13). Known complications of HFL, such as burns, skin breakdown, and hypo- and hyperpigmentation were not observed. Conclusions: HFL therapy is safe for photorejuvenation as deep as 425μ and among Fitzpatrick skin types I-VI, who are especially susceptible to epidermal injury. Combining HFL with rhytidectomy is not associated with greater complications than rhytidectomy alone, offering a promising combined solution for comprehensive facial rejuvenation. Expanding the parameters of safe HFL is instrumental in optimizing clinical outcomes of facial rejuvenation.